Using the Washington Group/ UNICEF Child Functioning Module in an early childhood setting in rural Malawi

• In Event: The equity initiative: screening & identification of disabilities and special learning needs

Proposal

Introduction
Standardised and internationally validated tools and metrics are vital to measure disability among children and monitor their participation in services and interventions. The recently launched UNICEF/ Washington Group Child Functioning Module (CFM) builds on, and improves the UNICEF 10 Question Screen for disability, and assesses functional difficulties of children aged 2-17 years in in different domains including hearing, vision, communication/ comprehension, learning, mobility and emotions. Sightsavers, and partners, recently conducted a cross-sectional survey among children aged 2-6 years attending early childhood centres in rural Malawi as part of baseline data collection for a cluster randomised control trial. In addition to the CFM a developmental assessment tool was applied and results were compared to understand the relationship between the measures.

Methods
Forty-eight early childhood centres and over 900 children aged 2-6 years were randomly selected and enrolled in the study. The CFM was administered to the principal caregivers of children in addition to other tools including a two domains of a locally developed and validated Malawian Developmental Assessment Tool (MDAT). Data were captured by trained teams using electronic data capture devices and analysed using Stata version 15. A binary measure of disability was calculated and univariate associations with other data calculated using chi-squared tests. A multivariate model was developed with the factors found to be univariately associated with disability. Cohen’s Kappa coefficients were calculated to understand the levels of agreements between the tools.

Results
Data was collected from 935 children, 44.7% of whom were male and 78.1% of whom were aged 2-4 years. 100 (10.7%) of the 935 children were identified as having a functional difficulty when using the WGCFM recommended cut-off. Functional difficulty did not appear to be linked to sex, but was more likely among older children (5+) than the younger group. Functional difficulty and developmental delay were also found to be closely linked.

Conclusion
The study highlights the usefulness of the CFM in measuring difficulties in various functional domains among young children. Functional difficulties and developmental delay are associated but not collinear and nuance around the age of onset of delay is important to understand. Early childhood programmes are important for the development of all children, and potentially the avoidance of developmental delay in low-income settings.

Authors

• Emma Jolley, Sightsavers

• Elena Schmidt, Sightsavers